Associations Among Childhood Trauma, Adolescent Problem Behaviors, and Adverse Adult Outcomes in Substance-Abusing Women Offenders.

This article explores relationships among exposure to childhood abuse and traumatic events, adolescent conduct problems and substance abuse, and adult psychological distress and criminal behaviors in a sample of substance-abusing women offenders (N = 440). Latent variable structural equation models revealed direct relationships between several childhood traumatic events and greater adolescent conduct problems and substance abuse. Conduct problems predicted more adult criminal behavior, and adolescent substance abuse predicted higher levels of current psychological distress. There were direct relationships between several types of traumatic events and current psychological distress and between traumatic events and specific criminal behaviors. Ethnic differences were also found, suggesting different pathways to criminal behavior. The findings underscore the need to provide trauma-related services for substance-abusing women offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical characteristics of adults reporting repressed, recovered, or continuous memories of childhood sexual abuse.

The authors assessed women and men who either reported continuous memories of their childhood sexual abuse (CSA, n = 92), reported recovering memories of CSA (n = 38), reported believing they harbored repressed memories of CSA (n = 42), or reported never having been sexually abused (n = 36). Men and women were indistinguishable on all clinical and psychometric measures. The 3 groups that reported abuse scored similarly on measures of anxiety, depression, dissociation, and absorption. These groups also scored higher than the control group. Inconsistent with betrayal trauma theory, recovered memory participants were not more likely to report abuse by a parent or stepparent than were continuous memory participants. Rates of depression and posttraumatic stress disorder did not differ between the continuous and recovered memory groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without posttraumatic stress disorder

The authors used a directed-forgetting task to investigate whether psychiatrically impaired adult survivors of childhood sexual abuse exhibit an avoidant encoding style and impaired memory for trauma cues. The authors tested women with abuse histories, either with or without posttraumatic stress disorder (PTSD), and women with neither abuse histories nor PTSD. The women saw intermixed trauma words (e.g., molested), positive words (e.g., confident), and categorized neutral words (e.g., mailbox) on a computer screen and were instructed either to remember or to forget each word. Relative to the other groups, the PTSD group did not exhibit recall deficits for trauma-related to-be-remembered words, nor did they recall fewer trauma-related to-be-forgotten words than other words. Instead, they exhibited recall deficits for positive and neutral words they were supposed to remember. These data are inconsistent with the hypothesis that impaired survivors exhibit avoidant encoding and impaired memory for traumatic information.     

Sexual abuse trauma among Chinese survivors

OBJECTIVE: As an initial effort to examine Chinese sexual abuse trauma in relation to the cultural construction of sexual victimization of women, this study applies Finkelhor and Browne's (1985) traumagenic dynamics model to examine post-abuse trauma among Chinese child and adolescent survivors in Taiwan. In analyzing sexual abuse trauma in the context of Chinese patriarchal familialism and cultural fetish for female chastity, this study attempts to explore cultural constructional process of sexual abuse in Chinese society. METHOD: This study conducted in-depth interviews with 19 survivors of, and three social workers on, sexual abuse in Taiwan. These interviews were guided by a semi-structured questionnaire on sexual abuse incidents and post-abuse responses/concerns, and had generated a total of 84 pages of written reports, which serve as the text-data for the analysis. RESULTS: This study identifies sexual stigmatization and senses of disempowerment and betrayal as the most pervasive trauma complex among Chinese sexual abuse survivors in Taiwan. This study found that, in addition to lowering self-esteem, sexual stigmatization results in polarized sexuality among adolescent survivors, as manifested in aversion to and preoccupation with sexuality. The abuse-induced disempowerment is manifested in the survivors' fear for personal safety and heightened sense of vulnerability to re-victimization. The sense of betrayal results in interpersonal difficulties as manifested in self-imposed isolation from others and/or suspicious attitudes toward others, which further impair the survivor's efficacy in meeting her abuse-induced clinging need. CONCLUSIONS: Overall, this study observes similar traumatic symptoms between Chinese survivors and their American counterparts as documented in the literature. Nevertheless, this study observes the sexual stigmatization represents the most prevailing post-abuse trauma among Chinese sexual abuse survivors, and reflects the patriarchal fetish for female chastity in the Chinese cultural construction of sexual victimization.     

Maltreated children's memory: Accuracy, suggestibility, and psychopathology.

Memory, suggestibility, stress arousal, and trauma-related psychopathology were examined in 328 3- to 16-year-olds involved in forensic investigations of abuse and neglect. Children's memory and suggestibility were assessed for a medical examination and venipuncture. Being older and scoring higher in cognitive functioning were related to fewer inaccuracies. In addition, cortisol level and trauma symptoms in children who reported more dissociative tendencies were associated with increased memory error, whereas cortisol level and trauma symptoms were not associated with increased error for children who reported fewer dissociative tendencies. Sexual and/or physical abuse predicted greater accuracy. The study contributes important new information to scientific understanding of maltreatment, psychopathology, and eyewitness memory in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood Sexual Abuse, Disordered Eating, Alexithymia, and General Distress: A Mediation Model.

Drawing from trauma-related theory (e.g., M. F. Schwartz & P. Gay, 1996), this article presents a model of associations among child sexual abuse (CSA), psychological distress, alexithymia, and disordered eating (DE). Structural equation modeling was used to test this conceptual model with a sample of female college students (N = 589). Results indicate that CSA is not directly associated with DE. Instead, CSA is associated with psychological distress, which is further related to alexithymia. Additionally, bootstrapping analyses were used to show that distress and alexithymia mediate the relationship between CSA and DE. Finally, restrictive eating behaviors and attitudes mediate between alexithymia and bulimic behaviors. This latter pathway was shown to be important to the model by the analysis of a 2nd, nested model. Although this model is only one of many possible, these results point to a weak but significant complex relation between CSA and DE. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of risk and resilience factors associated with posttraumatic stress symptoms and depression symptoms among Jews and Arabs exposed to repeated acts of terrorism in Israel.

In the first prospective study, to our knowledge, of the impact of ongoing terrorism and political violence, we analyzed nationally representative data from 560 Jews and 182 Arabs in Israel over a 6-month period. Based on Conservation of Resources (COR) theory (Hobfoll, 1989, 1998), we predicted that exposure to terrorism and political violence would result in psychosocial and economic resource loss and resource lack, which in turn, would be primary predictors of increases in symptoms of posttraumatic stress (PTS) and depression. We also predicted that trauma exposure and PTS symptoms, in particular, would be related to ethnocentrism and support for political violence. Furthermore, based on theory and prior research, we predicted that posttraumatic growth (PTG) would be related to a worsening of symptoms of distress and that distress would be related to increased ethnocentrism and support for extreme political violence for their “cause.” Women, older individuals, and Arabs (compared with Jews) were more likely to have continued psychological distress over time. In addition, using simultaneous equation modeling, we found good fit for a structural model that partially supported our hypotheses. Psychosocial resource loss, PTG, and social support had direct and indirect effects on psychological distress. Political attitudes tended to harden over time but were not prospectively related to PTS or depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood and Adolescent Sexual Abuse of Community Women: Mediated Effects on Psychological Distress and Social Relationships.

Possible mediators of sexual abuse severity were tested on the basis of D. Finkelhor and A. Browne's (1985) traumagenic dynamics model with 178 low-income African American, European American, and Mexican American community women interviewed for Project HOW: Health Outcomes of Women. This subsample reported contact sexual abuse before the age of 18 years. Severity was level of force, number of perpetrators, relationship to perpetrator, and age at first assault. As expected, structural equation modeling showed powerlessness, and stigmatization largely mediated the effects of sexual abuse severity on women's psychological distress in adulthood. Powerlessness also mediated the effects of severity on maladaptive social relationships. The expected path from betrayal to relationships was nonsignificant. Overall, the results support extension of D. Finkelhor and A. Browne's model. Possible interventions are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of low-severity violence to women's health

OBJECTIVE: To determine if women who experience low-severity violence differ in numbers of physical symptoms, psychological distress, or substance abuse from women who have never been abused and from women who experience high-severity violence. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Four community-based, primary care, internal medicine practices. PATIENTS: Survey respondents were 1,931 women aged 18 years or older. SURVEY DESIGN: Survey included questions on violence; a checklist of 22 physical symptoms; the Symptom Checklist-22 (SCL-22) to measure depression, anxiety, somatization, and self-esteem; CAGE questions for alcohol use; and questions about past medical history. Low-severity violence patients had been "pushed or grabbed" or had someone "threaten to hurt them or someone they love" in the year prior to presentation. High-severity violence patients had been hit, slapped, kicked, burned, choked, or threatened or hurt with a weapon. MAIN RESULTS: Of the 1,931 women, 47 met criteria for current low-severity violence without prior abuse, and 79 met criteria for current high-severity violence without prior abuse, and 1,257 had never experienced violence. The remaining patients reported either childhood violence or past adult abuse. When adjusted for socioeconomic characteristics, the number of physical symptoms increased with increasing severity of violence (4.3 for no violence, 5.3 for low-severity violence, 6.4 for high-severity violence, p < .0001). Psychological distress also increased with increasing severity of violence (mean total SCL22 scores 32.6 for no violence, 35.7 for low-severity violence, 39.5 for high-severity violence, p < .0001). Women with any current violence were more likely to have a history of substance abuse (prevalence ratio [PR] 1.8 for low-severity, 1.9 for high-severity violence) and to have a substance-abusing partner (PR 2.4 for both violence groups). CONCLUSIONS: In this study, even low-severity violence was associated with physical and psychological health problems in women. The data suggest a dose-response relation between the severity of violence and the degree of physical and psychological distress.     

Betrayal and revictimization: Preliminary findings.

The link between childhood sexual abuse and subsequent sexual, emotional, and physical revictimization has been widely reported. The literature is limited, however, in its exploration of the extent to which the level of betrayal inherent in a given childhood traumatic experience affects the likelihood of experiencing similar revictimization in adolescence and adulthood. This study assessed revictimization within a betrayal trauma framework among a sample of 271 college students. As predicted, individuals who reported experiencing high-betrayal trauma at any time point (childhood, adolescence, or adulthood) were more likely to report experiences of trauma high in betrayal during adolescence and adulthood. Relative risk ratios suggest that those who experience childhood trauma high in betrayal are 4.31 times more likely to be victimized in adolescence and 5.44 times more likely to be victimized in adulthood. Logistic regression analyses identified rate of childhood high-betrayal traumas and high levels of traumatic symptoms as significant predictors of high-betrayal trauma victimization in adolescence. Finally, participants’ responses to an exploratory self-report measure examining the relationship among revictimization, awareness for interpersonal betrayals, and response to betrayals in interpersonal contexts were analyzed. Preliminary findings indicate that revictimization risk may be linked to inaccurate identification of specific intimate partner betrayals and the inability to engage in proper self-protection. Suggestions for future research and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

ESR and U-series analyses of teeth from the palaeoanthropological site of Hexian, Anhui Province, China

Male substance abuse patients with posttraumatic stress disorder (PTSD) (SA-PTSD; N = 140) were compared to patients with only substance use disorders (SA-only; N = 1,262), and those with other Axis I diagnoses (SA-PSY; N = 228) on changes during substance abuse treatment. Diagnoses were determined by chart review, and patients completed questionnaires assessing coping, cognitions, and psychological distress. Although SA-PTSD patients improved on outcomes during treatment, they showed less benefit relative to SA-only patients. At discharge, SA-PTSD patients reported less use of effective coping styles, and endorsed more positive beliefs about substance use than SA-only patients. They had more psychological distress than SA-only and SA-PSY patients. More counseling sessions devoted to substance abuse and family problems, and increased involvement in 12-step activities partially counteracted the negative effects of having a PTSD diagnosis on several outcomes. SA-PTSD patients reported fewer psychological symptoms at discharge in programs that were high in support and order/organization.     

Distress Tolerance as a Predictor of Early Treatment Dropout in a Residential Substance Abuse Treatment Facility.

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of a screening instrument in women's health care: detecting relationships among victimization history, psychological distress, and medical complaints

The interactive relationship between psychological distress and physical health is a particularly salient one for women. Routine screening for abuse history and current psychological disturbance is essential in providing comprehensive patient care. The present study examines the utility of a brief screening measure in detecting psychological factors in female patients at a primary care facility. Sixty-nine percent of 108 women screened at a women's health clinic reported a history of trauma and almost half (49%) reported having been sexually harassed. Women presenting to treatment for gynecological problems were more likely to be victims of sexual assault and were more likely to report a history of childhood sexual abuse. In addition, women seeking specialized health care also reported increased rates of stress. Relationships among victimization histories, substance use, and eating disturbances were also found. These data suggest the importance of assessing psychological disturbances and trauma histories as part of a comprehensive medical evaluation.     

Trauma, binge eating, and the “strong Black woman”.

Objective: The primary goal of this study was to test a culturally specific model of binge eating in African American female trauma survivors, investigating potential mechanisms through which trauma exposure and distress were related to binge eating symptomatology. Method: Participants were 179 African American female trauma survivors who completed questionnaires about traumatic experiences; emotional inhibition/regulation difficulties; self-silencing (prioritizing others' needs and adopting external self-evaluation standards); eating for psychological reasons; binge eating; and internalization of “Strong Black Woman” (SBW) ideology, an important cultural symbol emphasizing strength and self-sufficiency. Results: Structural path analysis supported the proposed model in which SBW ideology, emotional inhibition/regulation difficulties, and eating for psychological reasons mediated the relationship between trauma exposure/distress and binge eating. The proposed model provided better fit to the data than several competing models. Conclusions: These findings suggest that among African American trauma survivors, trauma exposure and distress predict greater internalization of SBW ideology, which is associated with emotional inhibition/regulation difficulties, eating for psychological reasons, and ultimately binge eating. Implications of these findings for assessment, treatment, and prevention efforts are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive Adjustment to Threatening Events: An Organismic Valuing Theory of Growth Through Adversity.

A positive psychological theory of growth through adversity is proposed. The organismic valuing theory of growth through adversity posits an intrinsic motivation toward growth, showing how this leads to the states of intrusion and avoidance that are characteristic of cognitive-emotional processing after trauma. The theory posits 3 possible outcomes of this cognitive-emotional processing, namely, assimilation, negative accommodation, and positive accommodation. The theory shows how the organismic valuing process will automatically lead to the actualization of positive changes in psychological well-being, through the positive accommodation of the new trauma-related information, provided that the social environment is able to support this positive accommodation process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with intergenerational family conflict: Comparison of Asian American, Hispanic, and European American college students.

Using a stress-coping framework, the authors examined indirect and direct coping strategies as potential mediators in the relationship between intergenerational family conflict and psychological distress in Asian American, Hispanic, and European American college students. Asian American college students reported the highest likelihood of family conflict. Students from all cultural groups also used direct coping slightly more often than they did indirect coping. Only indirect coping mediated the effect of family conflict on distress for Asian Americans and European Americans, but it did so in the opposite direction than hypothesized. For these two cultural groups, indirect coping fully accounted for the variance shared between family conflict and psychological distress. For Hispanics, indirect coping partially mediated the effect of family conflict on psychological distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptomatic clients and memories of childhood abuse: What the trauma and child sexual abuse literature tells us.

In recent years, the delayed recall of memories of childhood abuse has been the subject of increasingly heated societal debate. The American Psychological Association Working Group on Investigation of Memories of Childhood Abuse was charged with reviewing relevant literature and making recommendations for future research directions as well as for clinical training and practice. This article reviews the trauma and child sexual abuse literatures by examining the scope of the problem and placing the current controversy into its broader social/historical context. It then provides a review of selected literature on the following topics: (1) the nature and consequences of trauma, particularly with regard to its potential effect on memory, and with special attention to trauma occurring during childhood; (2) child sexual abuse as a unique and potentially very traumatic form of interpersonal victimization; (3) dissociation and its functions both as a psychological defense against the impact of trauma and as the mental mechanism that most likely accounts for the amnesia and hypermnesia commonly experienced by traumatized individuals; and (4) memory in adults reporting a history of child sexual abuse, using available empirical data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of breast cancer on Asian American and Anglo American women

This pilot study constitutes the first exploration of the impact of breast cancer on Asian American women. Three hypotheses guided this study: (1) Asian American women would choose breast conserving therapy and breast reconstruction at a lower rate than the Anglo American women due to cultural differences in body image, (2) Asian American women with breast cancer would express psychological distress somatically and Anglo American women would express distress emotionally, and acculturation levels of the Asian American women would modify the expressions of distress such that women with high acculturation will express distress more emotionally and less acculturated women would express distress more somatically, and (3) Asian American women would seek assistance for psychosocial problems at a significantly lower rate than Anglo women. Ethnicity, age, and levels of acculturation were found to be significant variables that had to be considered simultaneously. The three hypotheses were only partially supported: (1) Asian American women chose breast conserving therapy and adjuvant therapy at a significantly lower rate than the Anglo American women, (2) Contrary to the hypothesis, somatization did not appear to be a dominant form of symptom presentation for Asian American women regardless of level of acculturation, and (3) Asian American women sought professional assistance for psychosocial problems at a significantly lower rate than Anglo women. Asian American women reported using different modes of help-seeking behavior for emotional concerns and receiving different sources of social support than the Anglo American women. Cultural interpretations of the findings are offered to explain the differences in the physical, emotional, and social responses to the breast cancer experience of Asian American women compared with the Anglo Americans, and notably between the Chinese- and Japanese Americans as well. The findings of this study warrant more refined exploration in order to improve the medical, psychological and social outcomes for Asian American women with breast cancer.     

Using feminist, emotion-focused, and developmental approaches to enhance cognitive-behavioral therapies for posttraumatic stress disorder related to childhood sexual abuse.

A body of research indicates the efficacy of cognitive-behavioral interventions for the treatment of posttraumatic stress disorder (PTSD) subsequent to sexual assault in adulthood. The generalizability of these treatments to women who present with trauma symptoms associated with childhood sexual abuse (CSA) has yet to be shown, however. A number of characteristics and dynamics of CSA that make it unique from sexual assault in adulthood are described, specifically its disruption of normal childhood development, its impact on attachment style and interpersonal relationships, its inescapability, and the stigma attached to it. Then, drawing on the developmental, emotion-focused, and feminist literatures, a number of considerations that would enhance the application of cognitive- behavioral trauma therapies to the treatment of women with PTSD related to CSA are delineated. These considerations relate to providing clients with corrective interpersonal experiences, creating new relationship events, enhancing affect regulation skills before initiating exposure therapy, considering the time elapsed since the abuse, addressing themes of power, betrayal, self-blame, stigma, and sex-related cognitions and emotions, and helping clients develop a feminist consciousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-evaluative appraisals of coping capability and posttraumatic distress following motor vehicle accidents.

This study tested the importance of coping self-efficacy (CSE) perceptions and change in perceptions of CSE for recovery from motor vehicle accident (MVA) trauma. Data were collected 7 days following the accident (Time 1; n = 163), 1 month after the accident (Time 2; n = 91), and 3 months after the accident (Time 3; n = 70). Early changes in CSE (i.e., from Time 1 to Time 2) predicted posttraumatic distress at 3 months after MVA trauma, even after controlling for Time 1 or Time 2 posttraumatic distress and other trauma-related variables (i.e., accident responsibility, litigation involvement, and peritraumatic dissociation). Early changes in CSE perceptions, however, neither moderated nor mediated the effects of early posttraumatic distress (Time 1) on 3-month posttraumatic distress. Time 2 CSE levels, however, did mediate the relationship between acute posttraumatic distress (Time 1) and 3-month posttraumatic distress (Time 3). These findings highlight the importance of early interventions aimed at strengthening self-efficacy after MVA trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)